Guo Y, Lv X, Zhou Y, et al. Myofascial release for the treatment of pain and dysfunction in patients with chronic mechanical neck pain: Systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2022 Oct 27:2692155221136108. doi: 10.1177/02692155221136108. (Systematic review)

OBJECTIVE: To explore the effects of myofascial release (MFR) on pain and dysfunction in individuals with chronic mechanical neck pain (MNP).

DATA SOURCES: PubMed, Embase, Medline, Wiley Online Library, Web of Science, CNKI, VIP, WanFang Data, and the Cochrane Library were searched until 12 September 2022.

REVIEW METHODS: This study was registered in PROSPERO (CRD42022302485). Methodological quality was assessed using Cochrane risk of bias assessment, and the quality of the evidence followed the GRADE recommendation. The outcomes pain, cervical mobility (Flexion, Extension, Rotation, lateral flexion), trapezius and suboccipital pressure pain thresholds (PPT), neck disability index (NDI), and adverse effects were extracted.

RESULTS: After screening of 346 studies, 13 studies and 601 participants met the inclusion criteria. All studies were of moderate methodological quality. Compared with the control group, the participants in the MFR group showed significantly greater improvements trapezius PPT SMD 0.41 (95% CI 0.11-0.72), suboccipital PPT SMD 0.47 (95% CI 0.21-0.72), respectively. The differences were not significant to support the MFR treatment on pain, flexion, extension, rotation, lateral flexion angle, and NDI. None of the studies reported any adverse events.

CONCLUSION: This systematic review suggests that MFR is an effective treatment for the improvement of PPT of trapezius and suboccipital muscle in patients with chronic MNP. However, there is low to moderate evidence and may change over time.

Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 4 / 7
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Comments from MORE raters

Rehab Clinician (OT/PT) rater

As an acute care geriatric physical therapist, I find this article was not entirely useful to my practice. MFR has been used for years, so it is understood to be a good intervention for muscle soreness and stiffness in our profession.

Rehab Clinician (OT/PT) rater

It appears that this SR/MA was comprehensive in scope, well-designed, and rigorous in its approach. Inherent with SR/MA is the challenge that fragmented data are attempted to be combined and systematically analyzed; however, the specifics of each included study, perhaps most importantly the intervention itself, are often very different. The paper states, "MFR is a variety of manual therapy techniques..." Perhaps it would have been advisable to delineate the differences among the included studies better and perhaps include a column on their article tables on their respective limitations. Another main challenge is the fact that all included studies produced low- to, at best, moderate-quality evidence. Nonetheless, from a broad perspective, the results of this SR/MA add support to the widely-accepted belief that interventions typically categorized as "MFR" can improve outcomes in this condition.

Rehab Clinician (OT/PT) rater

It is always disappointing when the conclusions only report the positive findings that are of questionable clinical relevance and fail to add the negative or equivocal results they found (especially when these items likely have more clinically relevance e.g. NDI).

Rehab Clinician (OT/PT) rater

This is a thorough and useful review.
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